目的 分析甲巯咪唑致胰岛素自身免疫综合征（IAS）临床特点与发生规律，为适宜人群筛查及合理用药提供参考。方法 检索PubMed、EBSCO、中国知网（CNKI）、万方医学网及维普中文期刊（VIP）等数据库中有关甲巯咪唑致胰岛素自身免疫综合征（IAS）的个案报道，并对相关指标进行统计分析和关联性评价。检索时间为建库至2022年9月。结果 共得到27篇个案报道，中文19篇，英文8篇，文献质量评价均较高；发生IAS共计30例，其中女性风险高于男性（80.00% vs 20.00%），41～60岁年龄层（36.67%）、自由职业者（42.10%）发生占比最高，其次患者有过治疗中断或停药史也会影响IAS的发生；诱导期以21～30 d为主，占比37.04%，且相较于联合用药，单次给药差异有显著性（63.33% vs 23.33%）；关联性评价肯定4例（13.33%），很可能20例（66.67%），可能6例（20.00%）。结论 药学门诊或临床医生在对甲亢患者开具甲巯咪唑时，开展必要的药物流行病学问询可有效降低患者服用甲巯咪唑致IAS的发生风险。

Objective To analyze the clinical characteristics and occurrence regularity of insulin autoimmune syndrome induced by methimazole,and to provide reference for suitable population screening and rational drug use.Methods Case reports of insulin autoimmune syndrome (IAS) caused by methimazole were retrieved from PubMed,EBSCO,CNKI,Wanfang Medical Network,VIP,and other databases,and the relevant indicators were statistically analyzed and the correlation was evaluated.The retrieval time is from the establishment of the database to September 2022.Results There were 27 case reports,19 in Chinese and 8 in English.The literature quality evaluation was high.A total of 30 patients had IAS,among which female patients were at higher risk than male patients (80.00%vs 20.00%),aged 41 to 60 years old (36.67%),and freelancers (42.10%) accounted for the highest proportion.In addition,the occurrence of IAS was also affected by patients'history of treatment interruption or drug withdrawal.The induction period was mainly 21 to 30 d,accounting for 37.04%,and compared with the combination medication,the difference of single medication was significant (63.33%vs 23.33%).The association evaluation was positive in 4 cases (13.33%),probable in 20 cases (66.67%),and probable in 6 cases (20.00%).Conclusion When methimazole is administered to hyperthyroidism patients in pharmaceutical outpatient departments or clinicians,necessary pharmacoepidemiological inquiries can effectively reduce the risk of insulin autoimmune syndrome caused by methimazole administration in patients.

R977

国家自然科学基金资助项目(82004073);四川省科技厅科技计划苗子工程重点项目(2022JDRC0146);四川省医学会(恒瑞)科研基金专项科研课题(2021HR26)